1
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Zampoli M, Verstraete J, Nguyen-Khoa T, Sermet-Gaudelus I, Zar HJ, Gonska T, Morrow BM. β-adrenergic sweat test in children with inconclusive cystic fibrosis diagnosis: Do we need new reference ranges? Pediatr Pulmonol 2023; 58:187-196. [PMID: 36193559 PMCID: PMC10092537 DOI: 10.1002/ppul.26179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/18/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Investigating inconclusive cystic fibrosis (CF) diagnosis in children is difficult without advanced cystic fibrosis transmembrane conductance regulator (CFTR) function tests. This study investigated the utility of beta (β)-adrenergic sweat test to exclude CF in participants with inconclusive diagnosis (CF suspects) in South Africa. METHODS β-adrenergic sweat test and sweat chloride tests (SCT) were performed simultaneously in CF suspects and adult controls (healthy, CFTR heterozygotes and CF). Cholinergic and β-adrenergic induced sweat rate was measured by evaporimetry (transepithelial water loss [TEWL]: g H2 O/m2 /h) following intradermal injections. Next-generation sequencing of CFTR was performed in CF suspects. CF diagnosis was defined by genotype. RESULTS Thirty-seven controls (10 healthy, 14 CF, 13 CFTR heterozygotes) and 32 CF suspects (26 children; 6 adults) were enrolled. Six were excluded from formal analyses due to β-adrenergic sweat test failure. In adults, evaporimetry was superior to SCT for diagnosis of CF with β-adrenergic:cholinergic ratio TEWL ≤ 0.05 achieving 100% sensitivity and specificity. Twenty-two CF suspect children (age range: 3.4-15.6 years) completed β-adrenergic sweat testing of which none had CF confirmed by genotyping: β-adrenergic:cholinergic ratio > 0.05 successfully excluded CF in all but one child who was CFTR heterozygous. Median peak β-adrenergic TEWL and β-adrenergic:cholinergic ratio in CFTR negative and CFTR heterozygous children was significantly lower than adult controls. CONCLUSION β-adrenergic sweat test is more accurate than SCT for excluding CF in children with inconclusive diagnosis. Established reference ranges for β-adrenergic sweat test may not be suitable for children due to lower β-adrenergic sweat secretion compared to adults.
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Affiliation(s)
- Marco Zampoli
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Janine Verstraete
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Thao Nguyen-Khoa
- Laboratories of Biochemistry and Newborn screening, Necker-Enfants Malades Hospital Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence Maladies Rares Mucoviscidose et Maladies apparentées. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Paris, France
| | - Isabelle Sermet-Gaudelus
- Centre de Référence Maladies Rares Mucoviscidose et Maladies apparentées. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Paris, France.,European Respiratory Network for Rare Diseases of the Lung
| | - Heather J Zar
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Tanja Gonska
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Toronto, and The Program of Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda M Morrow
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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2
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Infield DT, Strickland KM, Gaggar A, McCarty NA. The molecular evolution of function in the CFTR chloride channel. J Gen Physiol 2021; 153:212705. [PMID: 34647973 PMCID: PMC8640958 DOI: 10.1085/jgp.202012625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/11/2021] [Accepted: 09/09/2021] [Indexed: 12/13/2022] Open
Abstract
The ATP-binding cassette (ABC) transporter superfamily includes many proteins of clinical relevance, with genes expressed in all domains of life. Although most members use the energy of ATP binding and hydrolysis to accomplish the active import or export of various substrates across membranes, the cystic fibrosis transmembrane conductance regulator (CFTR) is the only known animal ABC transporter that functions primarily as an ion channel. Defects in CFTR, which is closely related to ABCC subfamily members that bear function as bona fide transporters, underlie the lethal genetic disease cystic fibrosis. This article seeks to integrate structural, functional, and genomic data to begin to answer the critical question of how the function of CFTR evolved to exhibit regulated channel activity. We highlight several examples wherein preexisting features in ABCC transporters were functionally leveraged as is, or altered by molecular evolution, to ultimately support channel function. This includes features that may underlie (1) construction of an anionic channel pore from an anionic substrate transport pathway, (2) establishment and tuning of phosphoregulation, and (3) optimization of channel function by specialized ligand–channel interactions. We also discuss how divergence and conservation may help elucidate the pharmacology of important CFTR modulators.
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Affiliation(s)
- Daniel T Infield
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA
| | | | - Amit Gaggar
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL.,Program in Protease and Matrix Biology, University of Alabama at Birmingham, Birmingham, AL.,Birmingham Veterans Administration Medical Center, Birmingham, AL
| | - Nael A McCarty
- Department of Pediatrics, Emory University, Atlanta, GA.,Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Emory University, Atlanta, GA
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3
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Reynaerts A, Vermeulen F, Mottais A, Gohy S, Lebecque P, Frédérick R, Vanbever R, Leal T. Needle-free iontophoresis-driven β-adrenergic sweat rate test. J Cyst Fibros 2021; 21:407-415. [PMID: 34489187 DOI: 10.1016/j.jcf.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Two CFTR-dependent β-adrenergic sweat rate tests applying intradermal drug injections were reported to better define diagnosis and efficacy of CFTR-directed therapies. The aim of this work was to develop and test a needle-free image-based test and to provide an accurate analysis of the responses. METHODS The modified method was conducted by applying two successive iontophoresis sessions using the Macroduct device. Efficiency of drug delivery was tested by evaporimetry. Cholinergically stimulated sweating was evoked by pilocarpine iontophoresis. β-adrenergically stimulated sweating was obtained by iontophoresis of isoproterenol and aminophylline in the presence of atropine and ascorbic acid. A nonlinear mixed-effects (NLME) approach was applied to model volumes of sweat and subject-specific effects displaying inter- and intra-subject variability. RESULTS Iontophoresis provided successful transdermal delivery of all drugs, including almost neutral isoproterenol and aminophylline. Pilocarpine was used at a concentration ∼130-times lower than that used in the classical Gibson and Cooke sweat test. Addition of ascorbic acid lowered the pH of the solution, made it stable, prevented isoproterenol degradation and promoted drug iontophoresis. Maximal secretory capacity and kinetic rate of β-adrenergic responses were blunted in CF. A cutoff of 5.2 minutes for ET50, the time to reach the half maximal secretion, discriminated CF from controls with a 100% sensitivity and specificity. Heterozygous showed an apparently reduced kinetic rate and a preserved secretory capacity. CONCLUSION We tested a safe, well-tolerated needle-free image-based sweat test potentially applicable in children. Modelling responses by NLME allowed evaluating metrics of CFTR-dependent effects reflecting secretory capacity and kinetic rate.
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Affiliation(s)
- Audrey Reynaerts
- Louvain Center for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique; Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - François Vermeulen
- Cystic Fibrosis Center, Belgium; Katholieke Universiteit Leuven (UZLeuven), Leuven, Belgium
| | - Angélique Mottais
- Louvain Center for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique; Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Sophie Gohy
- Cystic Fibrosis Center, Belgium; Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Patrick Lebecque
- Cystic Fibrosis Center, Belgium; Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Raphaël Frédérick
- Medicinal Chemistry Research Lab, Louvain Drug Research Institute; Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Rita Vanbever
- Advanced Drug Delivery & Biomaterials, Louvain Drug Research Institute; Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Teresinha Leal
- Louvain Center for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique; Université catholique de Louvain (UCLouvain), Brussels, Belgium.
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4
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Sermet-Gaudelus I, Brouard J, Audrézet MP, Couderc Kohen L, Weiss L, Wizla N, Vrielynck S, LLerena K, Le Bourgeois M, Deneuville E, Remus N, Nguyen-Khoa T, Raynal C, Roussey M, Girodon E. Guidelines for the clinical management and follow-up of infants with inconclusive cystic fibrosis diagnosis through newborn screening. Arch Pediatr 2017; 24:e1-e14. [PMID: 29174009 DOI: 10.1016/j.arcped.2017.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 06/21/2017] [Accepted: 07/04/2017] [Indexed: 01/17/2023]
Abstract
Neonatal screening for cystic fibrosis (CF) can detect infants with elevated immunoreactive trypsinogen (IRT) levels and inconclusive sweat tests and/or CFTR DNA results. These cases of uncertain diagnosis are defined by (1) either the presence of at most one CF-associated cystic fibrosis transmembrane conductance regulator (CFTR) mutation with sweat chloride values between 30 and 59mmol/L or (2) two CFTR mutations with at least one of unknown pathogenic potential and a sweat chloride concentration below 60mmol/L. This encompasses various clinical situations whose progression cannot be predicted. In these cases, a sweat chloride test has to be repeated at 12 months, and if possible at 6 and 24 months of life along with extended CFTR sequencing to detect rare mutations. When the diagnosis is not definite, CFTR functional explorations may provide a better understanding of CFTR dysfunction. The initial evaluation of these infants must be conducted in dedicated CF reference centers and should include bacteriological sputum analysis, chest radiology, and fecal elastase assay. The primary care physicians in charge of these patients should be familiar with the current management of CF and should work in collaboration with CF centers. A follow-up should be performed in a CF reference center at 3, 6, and 12 months of life and every year thereafter. Any symptom indicative of CF requires immediate reevaluation of the diagnosis. These guidelines were established by the "neonatal screening and difficult diagnoses" working group of the French CF society. Their objective is to standardize the management of infants with unclear diagnosis.
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Affiliation(s)
- I Sermet-Gaudelus
- Cystic fibrosis center, Necker-Enfants-Malades hospital, 75015 Paris, France; Inserm U1151, 75993 Paris, France.
| | - J Brouard
- Cystic fibrosis reference center, hôpital de la Côte-de-Nacre, 14033 Caen, France
| | - M-P Audrézet
- Molecular genetic laboratory, CHRU de Brest, 29609 Brest, France
| | - L Couderc Kohen
- Cystic fibrosis reference center, Charles-Nicolle hospital, 76000 Rouen, France
| | - L Weiss
- Cystic fibrosis reference center, Hautepierre hospital, 67200 Strasbourg, France
| | - N Wizla
- Cystic fibrosis reference center, Jeanne-de-Flandres hospital, 59000 Lille, France
| | - S Vrielynck
- Cystic fibrosis reference center, child and mother hospital, 69677 Lyon, France
| | - K LLerena
- Cystic fibrosis center, university hospital, 38700 Grenoble, France
| | - M Le Bourgeois
- Cystic fibrosis center, Necker-Enfants-Malades hospital, 75015 Paris, France
| | - E Deneuville
- Cystic fibrosis center, CHU de Rennes, 35000 Rennes, France
| | - N Remus
- Cystic fibrosis center, Créteil intercommunal hospital, 94000 Créteil, France
| | - T Nguyen-Khoa
- Cystic fibrosis center, Necker-Enfants-Malades hospital, 75015 Paris, France
| | - C Raynal
- UMR 5535, molecular genetic institute, 34293 Montpellier, France
| | - M Roussey
- Association française pour le dépistage et la prévention des handicaps de l'Enfant, 75015 Paris, France
| | - E Girodon
- Inserm U1151, 75993 Paris, France; Molecular genetics laboratory, Cochin hospital, 75014 Paris, France
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5
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Guimbellot J, Sharma J, Rowe SM. Toward inclusive therapy with CFTR modulators: Progress and challenges. Pediatr Pulmonol 2017; 52:S4-S14. [PMID: 28881097 PMCID: PMC6208153 DOI: 10.1002/ppul.23773] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/29/2017] [Indexed: 12/29/2022]
Abstract
Cystic fibrosis is caused by gene mutations that result in an abnormal Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein on the surface of cells. CFTR modulators are a novel class of drugs that directly target the molecular defect. CFTR modulators include potentiators that result in improved activity of the channel; correctors that help the protein traffic to the cell surface properly; and readthrough agents that restore full-length CFTR by suppression of premature termination codons, among other novel classes more recently established. While some of these drugs, CFTR potentiators in particular, have provided remarkable improvements for CF patients, others have yet to achieve profoundly improved outcomes, and many CF patients are not yet impacted by CFTR modulators due to lack of knowledge regarding susceptibility of their mutations to treatment. One limitation to expanding these types of therapies to the maximum number of patients with CF is the lack of rigorously validated clinical biomarkers that can determine efficacy on an individual basis, as well as few pre-clinical tools that can predict whether an individual with a rare combination of mutant alleles will respond to a particular CFTR modulator regimen. In this review, we discuss the various groups of CFTR modulators and their status in clinical development, as well as address the current literature on biomarkers, pre-clinical cell-based tools, and the role of pharmacometrics in creating therapeutic strategies to improve the lives of all patients with cystic fibrosis, regardless of their specific mutation.
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Affiliation(s)
- Jennifer Guimbellot
- Departments of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jyoti Sharma
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, Alabama
- Cell Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven M. Rowe
- Departments of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, Alabama
- Cell Developmental and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama
- Departments of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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6
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Servidoni MF, Gomez CCS, Marson FAL, Toro AADC, Ribeiro MÂGDO, Ribeiro JD, Ribeiro AF. Sweat test and cystic fibrosis: overview of test performance at public and private centers in the state of São Paulo, Brazil. J Bras Pneumol 2017; 43:121-128. [PMID: 28538779 PMCID: PMC5474375 DOI: 10.1590/s1806-37562016000000076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 01/06/2017] [Indexed: 12/15/2022] Open
Abstract
Objective: The sweat test (ST) measures chloride levels in sweat and is considered the gold standard for the diagnosis of cystic fibrosis (CF). However, the reliability of a ST depends on their being performed by experienced technicians and in accordance with strict guidelines. Our aim was to evaluate how sweat stimulation, sweat collection, and chloride measurement are performed at 14 centers (9 public centers and 5 private centers) that routinely perform STs in the state of São Paulo, which has the highest frequency of CF in Brazil. Methods: This was a cross-sectional cohort study, using a standardized questionnaire administered in loco to the staff responsible for conducting STs. Results: No uniformity regarding the procedures was found among the centers. Most centers were noncompliant with the international guidelines, especially regarding the collection of sweat (the samples were insufficient in 10-50% of the subjects tested); availability of stimulation equipment (which was limited at 2 centers); modernity and certification of stimulation equipment (most of the equipment having been used for 3-23 years); and written protocols (which were lacking at 12 centers). Knowledge of ST guidelines was evaluated at only 1 center. Conclusions: Our results show that STs largely deviate from internationally accepted guidelines at the participating centers. Therefore, there is an urgent need for standardization of STs, training of qualified personnel, and acquisition/certification of suitable equipment. These are essential conditions for a reliable diagnosis of CF, especially with the increasing demand due to newborn screening nationwide, and for the assessment of a possible clinical benefit from the use of modulator drugs.
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Affiliation(s)
- Maria Fátima Servidoni
- . Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil.,. Gastrocentro - Unidade de Endoscopia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil
| | - Carla Cristina Souza Gomez
- . Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil
| | - Fernando Augusto Lima Marson
- . Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil.,. Departamento de Genética Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil
| | | | | | - José Dirceu Ribeiro
- . Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil
| | - Antônio Fernando Ribeiro
- . Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil
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7
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Sermet-Gaudelus I, Brouard J, Audrézet MP, Couderc Kohen L, Weiss L, Wizla N, Vrielynck S, LLerena K, Le Bourgeois M, Deneuville E, Remus N, Nguyen-Khoa T, Raynal C, Roussey M, Girodon E. [Management of infants whose diagnosis is inconclusive at neonatal screening for cystic fibrosis]. Arch Pediatr 2017; 24:401-414. [PMID: 28258861 DOI: 10.1016/j.arcped.2017.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
Neonatal screening for cystic fibrosis (CF) may detect infants with elevated immunoreactive trypsinogen (IRT) levels but with inconclusive sweat tests and/or DNA results. This includes cases associating (1) either the presence of at most one CF-causing mutation and sweat chloride values between 30 and 59mmol/L or (2) two CFTR mutations with at least one of unknown pathogenicity and a sweat chloride below 60mmol/L. This encompasses different clinical situations whose progression cannot be predicted. These cases require redoing the sweat test at 12 months and if possible at 6 and 24 months of life. This must be associated with extended genotyping. CFTR functional explorations can also help by investigating CFTR dysfunction. These infants must be initially evaluated in dedicated CF centers including bacteriological sputum analysis, chest radiology and fecal elastase dosage. A home practitioner must be informed of the specificity of follow-up. These infants will be reviewed in the CF center at 3, 6 and 12 months and every year. Any CF-related symptom requires reevaluation of the diagnosis. These guidelines were established by the "neonatal screening and difficult diagnoses" working group of the French CF Society. They aim to standardize management of infants with unclear diagnosis in French CF centers.
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Affiliation(s)
- I Sermet-Gaudelus
- Centre de ressources et de compétences en mucoviscidose, hôpital Necker-Enfants Malades, 149, rue de Sévres, 75015 Paris, France; Inserm U 1151, Paris, France.
| | - J Brouard
- Centre de ressources et de compétences en mucoviscidose, hôpital de la Côte-de-Nacre, 14033 Caen, France
| | - M-P Audrézet
- Laboratoire de génétique moléculaire, CHRU de Brest, 29609 Brest, France
| | - L Couderc Kohen
- Centre de ressources et de compétences en mucoviscidose, hôpital Charles-Nicolle, 76000 Rouen, France
| | - L Weiss
- Centre de ressources et de compétences en mucoviscidose, hôpital de Hautepierre, 67200 Strasbourg, France
| | - N Wizla
- Centre de ressources et de compétences en mucoviscidose, hôpital Jeanne-de-Flandres, 59000 Lille, France
| | - S Vrielynck
- Centre de ressources et de compétences en mucoviscidose, hôpital Mère-Enfant, 69677 Lyon, France
| | - K LLerena
- Centre de ressources et de compétences en mucoviscidose, CHU, 38700 Grenoble, France
| | - M Le Bourgeois
- Centre de ressources et de compétences en mucoviscidose, hôpital Necker-Enfants Malades, 149, rue de Sévres, 75015 Paris, France
| | - E Deneuville
- Centre de ressources et de compétences en mucoviscidose, CHU, 35000 Rennes, France
| | - N Remus
- Centre de ressources et de compétences en mucoviscidose, hôpital InterCommunal de Créteil, 94000 Créteil, France
| | - T Nguyen-Khoa
- Centre de ressources et de compétences en mucoviscidose, hôpital Necker-Enfants Malades, 149, rue de Sévres, 75015 Paris, France
| | - C Raynal
- Institut de génétique moléculaire, UMR 5535, 34293 Montpellier, France
| | - M Roussey
- Association française pour le dépistage et la prévention des handicaps de l'enfant, 75015 Paris, France
| | - E Girodon
- Laboratoire de génétique moléculaire, hôpital Cochin, 75014 Paris, France
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8
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Faria AG, Marson FAL, Gomez CCDS, Ribeiro MÂGDO, Morais LB, Servidoni MDF, Bertuzzo CS, Sakano E, Goto M, Paschoal IA, Pereira MC, Hessel G, Levy CE, Toro AADC, Peixoto AO, Simões MCR, Lomazi EA, Nogueira RJN, Ribeiro AF, Ribeiro JD. Quality of sweat test (ST) based on the proportion of sweat sodium (Na) and sweat chloride (Cl) as diagnostic parameter of cystic fibrosis: are we on the right way? Diagn Pathol 2016; 11:103. [PMID: 27784314 PMCID: PMC5080702 DOI: 10.1186/s13000-016-0555-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To assess the quality of sweat test (ST) based on the proportion of sweat sodium and sweat chloride as diagnostic parameter of cystic fibrosis (CF). METHODS A retrospective study of 5,721 sweat samples and subsequent descriptive analysis were carried out. The test was considered "of good quality" (correct) when: (i) sweat chloride was lower than 60 mEq/L, and sweat sodium was higher than sweat chloride; (ii) sweat chloride was higher than 60 mEq/L, and sweat sodium was lower than sweat chloride. RESULTS The study included 5,692/5,721 sweat samples of ST which had been requested due to clinical presentations compatible with CF and/or neonatal screenings with altered immunoreactive trypsinogen values. Considering the proportion of sweat sodium and sweat chloride as ST quality parameter, the test was performed correctly in 5,023/5,692 (88.2 %) sweat samples. The sweat chloride test results were grouped into four reference ranges for chloride (i) chloride < 30 mEq/L: 3,651/5,692 (64.1 %); (ii) chloride ≥ 30 mEq/L to < 40 mEq/L: 652/5,692 (11.5 %); (iii) ≥ 40 mEq/L to < 60 mEq/L: 673/5,692 (11.8 %); (iv) ≥ 60 mEq/L: 716/5,692 (12.6 %). In the comparative analysis, there was no association between ST quality and: (i) symptoms to indicate a ST [respiratory (p = 0.084), digestive (p = 0.753), nutritional (p = 0.824), and others (p = 0.136)], (ii) sweat weight (p = 0.416). However, there was a positive association with: (i) gender, (ii) results of ST (p < 0.001), (iii) chloride/sodium ratio (p < 0.001), (iv) subject's age at the time of ST [grouped according to category (p < 0.001) and numerical order (p < 0.001)]. For the subset of 169 patients with CF and two CFTR mutations Class I, II and/or III, in comparative analysis, there was a positive association with: (i) sweat chloride/sodium ratio (p < 0.001), (ii) sweat chloride values (p = 0.047), (iii) subject's age at the time of the ST grouped by numerical order (p = 0.001). CONCLUSIONS Considering that the quality of ST can be assessed by levels of sweat sodium and sweat chloride, an increasing number of low-quality tests could be observed in our sweat samples. The quality of the test was associated with important factors, such as gender, CF diagnosis, and subjects' age.
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Affiliation(s)
- Alethéa Guimarães Faria
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Tessália Vieira de Camargo, 126, Barão Geraldo, Cidade Universitária Zeferino Vaz, CEP: 13083-887 Campinas, São Paulo Brazil
| | | | - Maria Ângela Gonçalves de Oliveira Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lucas Brioschi Morais
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maria de Fátima Servidoni
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carmen Sílvia Bertuzzo
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Eulália Sakano
- Department of Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maura Goto
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Ilma Aparecida Paschoal
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Mônica Corso Pereira
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Gabriel Hessel
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carlos Emílio Levy
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | | | | | | | - José Dirceu Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Noninvasive metabolic profiling for painless diagnosis of human diseases and disorders. Future Sci OA 2016; 2:FSO106. [PMID: 28031956 PMCID: PMC5137983 DOI: 10.4155/fsoa-2015-0014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/29/2016] [Indexed: 12/16/2022] Open
Abstract
Metabolic profiling provides a powerful diagnostic tool complementary to genomics and proteomics. The pain, discomfort and probable iatrogenic injury associated with invasive or minimally invasive diagnostic methods, render them unsuitable in terms of patient compliance and participation. Metabolic profiling of biomatrices like urine, breath, saliva, sweat and feces, which can be collected in a painless manner, could be used for noninvasive diagnosis. This review article covers the noninvasive metabolic profiling studies that have exhibited diagnostic potential for diseases and disorders. Their potential applications are evident in different forms of cancer, metabolic disorders, infectious diseases, neurodegenerative disorders, rheumatic diseases and pulmonary diseases. Large scale clinical validation of such diagnostic methods is necessary in future.
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CFTR functional measurements in human models for diagnosis, prognosis and personalized therapy: Report on the pre-conference meeting to the 11th ECFS Basic Science Conference, Malta, 26-29 March 2014. J Cyst Fibros 2014; 13:363-72. [PMID: 24882694 DOI: 10.1016/j.jcf.2014.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Affiliation(s)
- Paul M Quinton
- Dept. Pediatrics, UC San Diego School of Medicine, Rady Children's Hospital, Division of Biomedical Sciences, UC Riverside School of Medicine, United States.
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Modification of the salivary secretion assay in F508del mice--the murine equivalent of the human sweat test. J Cyst Fibros 2013; 12:630-7. [PMID: 23768658 DOI: 10.1016/j.jcf.2013.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/06/2013] [Accepted: 05/13/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2005 Best and Quinton established the salivary secretion assay in mice for the in vivo characterization of new drugs against cystic fibrosis (CF). However, limited data are available and the predictive value of this in vivo assay for treatment effects in CF patients is not fully understood. METHODS Therefore, we revisited the salivary secretion assay and systematically investigated the salivary secretion rates in different murine backgrounds and sexes, as well as in different CF mouse models. Moreover, we established quantification of salivary chloride content. RESULTS We found a strain- and sex-dependency of salivary secretion rates and were able to confirm the decreased β-adrenergic salivary secretion response in CFTR knockout mice (CFTR(tm1Unc)) as well as in the F508del CFTR mice of different origins (CFTR(tm1Kth) and CFTR(tm1Eur)). In heterozygous Cftr+/- and Cftr+/F508del mice, the isoprenaline-stimulated salivary secretion rate and the Cl(-) content were intermediate between values measured in WT and CF mice, indicating that this assay is also able to detect CF carriership. Pilocarpine-induced abnormalities in saliva chloride content in CF mice resembled the changes observed in the human sweat test. CONCLUSIONS Determination of murine salivary chloride content in combination with salivary secretion rate in CF mice may render the salivary secretion assay as a powerful tool for validation of new CF treatments.
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Cystic fibrosis transmembrane conductance regulator gene abnormalities in patients with asthma and recurrent neutrophilic bronchitis. Can Respir J 2012; 19:46-8. [PMID: 22332135 DOI: 10.1155/2012/546702] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The present case series describes four patients with asthma, airway hyperresponsiveness and neutrophilic bronchitis who harboured abnormal cystic fibrosis transmembrance conductance regulator (CFTR) gene mutations. It serves both to alert clinicians to consider CFTR-related disease in both young and elderly patients with persistent neutrophilic bronchitis, and to highlight the potential utility of future genetic testing for CFTR abnormalities in patients with asthma and recurrent bronchitis or pansinusitis, and the role of nebulized hypertonic saline as a therapeutic option in these patients.
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Roth EK, Hirtz S, Duerr J, Wenning D, Eichler I, Seydewitz HH, Amaral MD, Mall MA. The K+ channel opener 1-EBIO potentiates residual function of mutant CFTR in rectal biopsies from cystic fibrosis patients. PLoS One 2011; 6:e24445. [PMID: 21909392 PMCID: PMC3164200 DOI: 10.1371/journal.pone.0024445] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 08/10/2011] [Indexed: 12/05/2022] Open
Abstract
Background The identification of strategies to improve mutant CFTR function remains a key priority in the development of new treatments for cystic fibrosis (CF). Previous studies demonstrated that the K+ channel opener 1-ethyl-2-benzimidazolone (1-EBIO) potentiates CFTR-mediated Cl− secretion in cultured cells and mouse colon. However, the effects of 1-EBIO on wild-type and mutant CFTR function in native human colonic tissues remain unknown. Methods We studied the effects of 1-EBIO on CFTR-mediated Cl− secretion in rectal biopsies from 47 CF patients carrying a wide spectrum of CFTR mutations and 57 age-matched controls. Rectal tissues were mounted in perfused micro-Ussing chambers and the effects of 1-EBIO were compared in control tissues, CF tissues expressing residual CFTR function and CF tissues with no detectable Cl− secretion. Results Studies in control tissues demonstrate that 1-EBIO activated CFTR-mediated Cl− secretion in the absence of cAMP-mediated stimulation and potentiated cAMP-induced Cl− secretion by 39.2±6.7% (P<0.001) via activation of basolateral Ca2+-activated and clotrimazole-sensitive KCNN4 K+ channels. In CF specimens, 1-EBIO potentiated cAMP-induced Cl− secretion in tissues with residual CFTR function by 44.4±11.5% (P<0.001), but had no effect on tissues lacking CFTR-mediated Cl−conductance. Conclusions We conclude that 1-EBIO potentiates Cl−secretion in native CF tissues expressing CFTR mutants with residual Cl− channel function by activation of basolateral KCNN4 K+ channels that increase the driving force for luminal Cl− exit. This mechanism may augment effects of CFTR correctors and potentiators that increase the number and/or activity of mutant CFTR channels at the cell surface and suggests KCNN4 as a therapeutic target for CF.
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Affiliation(s)
- Eva K. Roth
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Hirtz
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Julia Duerr
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Daniel Wenning
- Pediatric Gastroenterology and Hepatology, Department of Pediatrics I, University of Heidelberg, Heidelberg, Germany
| | - Irmgard Eichler
- Department of Pediatrics and Adolescent Medicine, University of Vienna, Vienna, Austria
| | - Hans H. Seydewitz
- Department of Pediatrics and Adolescent Medicine, Albert Ludwigs University, Freiburg, Germany
| | - Margarida D. Amaral
- Centre of Human Genetics, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal
- Department of Chemistry and Biochemistry, Faculty of Sciences, University of Lisboa, Lisboa, Portugal
| | - Marcus A. Mall
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
- * E-mail:
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De Boeck K, Derichs N, Fajac I, de Jonge H, Bronsveld I, Sermet I, Vermeulen F, Sheppard D, Cuppens H, Hug M, Melotti P, Middleton P, Wilschanski M. New clinical diagnostic procedures for cystic fibrosis in Europe. J Cyst Fibros 2011; 10 Suppl 2:S53-66. [DOI: 10.1016/s1569-1993(11)60009-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Hubert D, Brunswick P, Calvet JH, Dusser D, Fajac I. Abnormal electrochemical skin conductance in cystic fibrosis. J Cyst Fibros 2011; 10:15-20. [PMID: 20920895 DOI: 10.1016/j.jcf.2010.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 09/01/2010] [Accepted: 09/04/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Electrochemical skin conductance measurement is an active electrophysiologic method in which incremental low direct voltage is applied on the skin. It generates a current due to reverse iontophoresis which previous studies suggested to be mostly related to chloride anion movements. As sweat chloride movements upon electric stimulation were likely to be impaired in cystic fibrosis (CF) patients, we designed a proof-of-concept study to measure electrochemical skin conductance in CF patients and control subjects and to test the ability of this method to discriminate CF from controls. METHODS Electrochemical skin conductance was measured in 41 adult patients with classical CF and 20 healthy control subjects. Patients placed their hands and feet on nickel electrodes and an incremental low direct voltage was applied on the anode during 2min. The resulting voltage on the cathode and the current generated between anode and cathode were measured and from them, two electrochemical skin conductance variables were calculated: ESC, obtained when a low voltage of 1.6V was applied, and dESC which took into account electrochemical skin conductances obtained when low and high voltages were applied. RESULTS ESC measurements on hands and feet were significantly different in CF patients (on feet: 75±10μSi), as compared with control subjects (62±13μSi, p<0.0001); dESC was also significantly different and more discriminative in CF patients (on feet: 34±24μSi), as compared with control subjects (93±24μSi, p<0.0001). dESC measurement provided a diagnostic specificity of 1 and a sensitivity of 0.93. CONCLUSIONS These results show that electrochemical skin conductance which is easily and rapidly measured is abnormal in CF patients. Trial registry name in the European Clinical Trials Database (eudraCT): "EZSCAN MUCO1: Mesure de la conductance cutanée par chronoampérométrie", N°EUDRACT: 2007-A00221-52.
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Sermet-Gaudelus I, Munck A, Rota M, Roussey M, Feldmann D. Recommandations françaises pour la réalisation et l’interprétation du test de la sueur dans le cadre du dépistage néonatal de la mucoviscidose. Arch Pediatr 2010; 17:1349-58. [DOI: 10.1016/j.arcped.2010.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 06/24/2010] [Indexed: 11/26/2022]
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A new simple method for assessing sudomotor function: relevance in type 2 diabetes. DIABETES & METABOLISM 2010; 36:450-4. [PMID: 20739207 DOI: 10.1016/j.diabet.2010.05.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 05/27/2010] [Accepted: 05/30/2010] [Indexed: 01/06/2023]
Abstract
AIM The current sudomotor function tests are too time-consuming to be used for diabetic patients in daily practice. EZSCAN is a new, patented technology that measures electrochemical skin conductance (ESC) through reverse iontophoresis and chronoamperometry. The aim of the present study was to assess the sensitivity, specificity and reproducibility of the method in type 2 diabetic patients in comparison to control subjects with no risk of diabetes. METHODS A total of 133 type 2 diabetic patients and 41 control subjects were tested. Participants placed their hands and feet on nickel electrodes, and an incremental low direct current was applied to the anode for 2 min. ESC was calculated from the resulting voltage and generated current. ESC diagnostic accuracy was analyzed by ROC curve modeling, and reproducibility was assessed using Bland-Altman analysis. RESULTS The ESC of hands and feet was significantly reduced in diabetic patients (53±16μSi and 67±14μSi, respectively) compared with control subjects (68±16μSi and 80±7μSi, respectively; P<0.0001). ESC values had a sensitivity of 75% and specificity of 100%, with an area under the ROC curve of 0.88 at a threshold of 50% on the EZSCAN scale. Coefficients of variation in hand and foot measurements were 15 and 7%, respectively. CONCLUSION The good sensitivity, specificity and reproducibility of EZSCAN make it a feasible alternative for assessing sudomotor dysfunction, a clinical manifestation of autonomic neuropathy in diabetic patients. The test takes<3 min to perform, and requires neither special patient preparation nor medical personnel training.
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